Feasibility of Prehospital Physician Activation for Extracorporeal Cardiopulmonary Resuscitation

Extracorporeal cardiopulmonary resuscitation (eCPR) is associated with improved survival among out-of-hospital cardiac arrest (OHCA) patients with refractory ventricular tachycardia (VT) or ventricular fibrillation (VF). However, the ideal approach for integrating an eCPR program within an Emergency Medical Services (EMS) agency and local hospitals is unknown. The objective of this study was to investigate the feasibility of an integrated prehospital eCPR protocol activated by an EMS physician.

We conducted a feasibility study of a local, expert-derived prehospital eCPR activation protocol within a third-service EMS agency serving a mixed urban and rural population and a large, academic tertiary care center in North Carolina between 5/01/2024 - 5/19/2025. Adult OHCA patients at least18 years old but ≤ 60 with non-traumatic, witnessed cardiac arrest who received bystander CPR and had an initial rhythm of VT or VF that was refractory to three defibrillation attempts were eligible for eCPR activation. For eligible patients, paramedics consulted with an online EMS physician, who activated eCPR with subsequent intra-arrest transport for cannulation at the hospital. The primary outcome was the proportion of patients with non-traumatic OHCA who were eligible for eCPR. Secondary outcomes include the proportion of eligible patients with eCPR activation, eCPR cannulation attempted, successful cannulation, and survival to hospital discharge. Data were abstracted from the EMS and hospital electronic medical records.

During the one-year study period, 325 patients experienced non-traumatic OHCA, of whom 4.9% (16/325) were eligible for eCPR. These 16 patients had a median age of 54 years (IQR 47-59), 83.3% (13/16) were male, and 62.5% (10/16) were non-White. The eCPR protocol was activated for 62.5% (10/16). Among these, cannulation occurred in 50.0% (5/10). Survival to hospital discharge occurred in 50.0% (5/10) of the eCPR activation group whereas 33.3% (2/6) of the eligible patients in whom eCPR was not activated survived to hospital discharge.

Implementing an EMS physician activated eCPR protocol was feasible and had a modest number of eligible patients. Further investigation in a larger, multi-system study is needed to determine the impact on patient-centered outcomes.